Method of treating toxemia

ABSTRACT

A therapeutic agent for the treatment of toxemia, preeclampsia and eclampsia and a method for preparing the therapeutic agent are disclosed. The therapeutic agent is a stable pharmaceutical preparation containing, but not limited to, digestive/pancreatic enzymes. The therapeutic agent may be manufactured by a variety of encapsulation technologies. Delivery of the therapeutic agent may be made orally, through injection, by adherence of a medicated patch or by other methods. Further, a method of using the presence of chymotrypsin in the maternal GI tract as a biomarker, to determine the likelihood of developing preeclampsia, a pregnancy induced hypertension, and eclampsia/toxemia is disclosed.

CROSS-REFERENCE

This application is a divisional application of Ser. No. 12/047,818,filed Mar. 13, 2008, now U.S. Pat. No. 8,658,163, which is incorporatedherein by reference in its entirety, and to which application we claimpriority under 35 U.S.C. §121.

FIELD OF THE INVENTION

The invention relates to a treatment for pregnancy induced hypertension,preeclampsia, eclampsia, toxemia and related disorders of pregnancy, andmore particularly, to the use of digestive/pancreatic enzymes in thetreatment of pregnancy induced hypertension, preeclampsia, eclampsia andtoxemia that may occur during pregnancy.

BACKGROUND OF THE INVENTION

Every year thousands of women suffer from pregnancy inducedhypertension. While blood pressure during pregnancy is generally lowerthan in the non-pregnant state, some pregnant women will develophypertension. Hypertension during pregnancy can have a significantimpact on the mother and the fetus, including, but not limited to strokeor other cardiovascular complications. It is estimated that 7 out ofevery 100 pregnant women will develop toxemia/eclampsia and/orpre-eclampsia of which hypertension is the main presenting symptom. Mildtoxemia, also known as preeclampsia is monitored closely and usuallycauses few problems for the mother or child. Of note, toxemia, andeclampsia are often used interchangeably to refer to the same condition,and will be used interchangeably throughout the application.

There is no known cause for toxemia. What is known is that toxemiastarts to develop as the placenta begins to develop, although thecondition may not be detected until the latter part of pregnancy. Mostcases of toxemia happen with first pregnancies. Second and subsequentpregnancies are at lower risk, unless the woman is with a new partner.Since there is no known cause of toxemia, there is no way to determineif a woman is at risk for the condition before she gets pregnant.

Preeclampsia causes hypertension and proteinuria, manifesting most oftenafter the twentieth week of pregnancy. In the past, edema was considereda diagnostic criterion. Recently, however, it has been eliminated as arequirement for diagnosis. Preeclampsia causes vasospasm, a condition inwhich your blood vessels squeeze and then relax almost like a musclespasm. This causes the smooth lining of the blood vessels to becomedamaged and rough. Once this damage occurs, the body will send out cellsto repair the damage. The cells that arrive first are platelets. Asplatelets and other blood products try to repair the damage, they formlittle clots along the blood vessel wall causing the blood vessel tobecome even more narrow and further decreasing blood flow to the organs.The body continually makes new platelets; however, there is a limitedsupply of platelets in the body at any one time. Once they have becomedepleted, spontaneous bleeding can occur.

Other cells passing by the damaged lining of the blood vessels breakopen, often spilling their toxic contents. These toxic waste productscause high blood pressure and even more damage to other organs.Vasospasm and the miniature blood clots cause further damage bydecreasing blood flow and thus decreasing the oxygen supply to vitalorgans such as the brain, kidneys, and liver.

The term preeclampsia refers to the disease state before a seizure. Oncea woman has had a seizure with this disease, it then becomes eclampsia.Eclampsia includes hypertension and proteinuria. Preeclampsia may beclassified as mild or severe. Severe preeclampsia is characterized by(1) a systolic blood pressure in a known normotensive woman greater than140-160 mm Hg or diastolic blood pressure greater than 90-110 mm Hg on 2occasions at least 6 hours apart in a woman on bed rest and (2) thepresence of significant proteinuria. Proteinuria concentrationassociated with preeclampsia are in the 300 mg/24 hour urine range.Marked proteinuria is defined as 5 g or more of protein in a 24-hoururine collection.

Severe preeclampsia, at times, may be associated with oliguria, cerebralor visual disturbances, pulmonary edema or cyanosis, epigastric or rightupper quadrant abdominal pain, impaired liver function,thrombocytopenia, or intrauterine growth restriction. In mildpreeclampsia, hypertension and proteinuria are present, but not to theseextreme levels, and the patient has no evidence of other organdysfunction. As preeclapmsia develops into eclampsia/toxemia, oliguriaand other symptoms may be present. Many of the health problemsassociated with eclampsia/toxemia may be very dangerous to the motherand the child, and can result in severe morbidity and potentiallymortality for the mother and/or the child. Toxemia may cause liverand/or kidney damage or failure. It may cause problems with eyesightand, if left untreated for too long, may cause the maternal patient togo into seizures. These seizures can lead to coma and even death. Often,the progression of these symptoms can not be stopped and full blowntoxemia occurs, including kidney failure.

The etiology of preeclampsia is still unknown. Many areas have beenexplored including: the examination of the renin-angiotensin system,selective hormonal examination, including epinephrine, norepinephrine,and vasopressin. Further examination has included endothelin andprostaglandins, all without conclusion or an effective treatment forpreeclampsia and the potential resultant eclampsia/toxemia.

Since placental delivery reverses the symptoms of preeclampsia, itsuggests that the placenta may have a central role in the condition.Additionally, women with increased placental tissue for gestational age,those with hydatiform moles and/or twin or multiple pregnancies, have anincreased prevalence of preeclampsia. This, therefore, leads one toconsider the possibility that substances, such as human chorionicgonadotropin, which is high in a hydatiform mole, may be involved. Thislink between the placenta and the development of preeclampsia is key.

As the fertilized ovum begins to divide, it is known as a morula at thesixteen cell stage. As the morula enters the uterine cavity from thefallopian tube, it does not implant until day seven of gestation atwhich time it is termed a blastocyst. The trophoblastic cells of theblastocyst erode the uterine lining to form large pockets known aslacunae. The trophoblast now forms a divide in the cellular portion andthe syncytial portion. The outside covering of the syncytial portion isknown as the chorion. The chorion secretes human chorionic gonadotropinwhich prevents immune attack from the mother, and helps to maintain thecorpus luteum of pregnancy until the maternal/fetal exchange can takeplace through the placenta. This is the beginning of the formation ofthe placenta.

The cellular trophoblast, once it begins to proliferate without properchangeover to syncytial trophoblastic activity, may cause possiblesyncytial demise, thus reducing the amount of steroid hormone produced,and also reducing the possibility that the placenta will form correctly.The syncytial trophoblast further proliferates to form a highlyspecialized trophoblast, known as an extravillous trophoblast. Theextravillous trophoblast bores through the endometrium, extending to thedecidua and myometrium of the uterus. These extravillous trophoblastscontinue their invasion into the spiral arterioles of the uterus andreplace the endothelial and muscular linings of the uterine arterioles,leading to vasodilation of the uterine vasculature. This change ensuresa continued low resistance system, which potentiates maternal blood flowto the intervillous space and maintains adequate perfusion of thedeveloping fetus.

The mechanism by which the cellular trophoblast is reduced in itsproliferation such that the syncytial trophoblast can take over is thepresence of proteolytic enzymes, especially that of chymotrypsin. Theseproteases produced by the mother, especially chymotrypsin, are able torestrain the proliferation of the cellular trophoblast and theoverproduction of human chorionic gonadotropin. This mechanism wasoutlined by Ernest T. Krebs in 1949 (Medical Record, Vol. 162, No. 10,October 1949).

In preeclampsia, the lack of proliferation of the syncytial trophoblastsleads to a lack of extravillous trophoblasts and an improper boring intothe muscular lining of the uterine arterioles. This leads to vasospasmof the arteries of the uterine endometrium and results in ischemia,anoxia, necrosis, histamine and tyramine release. With the absence ofmarked vasodilation and the lumen of the vessels essentially occluded,blood flow and oxygen transfer to the fetus is diminished, leading tothe maternal manifestations of preeclampsia as well as the fetalmanifestations of oligohydramnios and intrauterine growth restriction(IUGR).

The resultant improper placental development results in placentalvascular endothelial dysfunction and a relative uteroplacentalinsufficiency. The vascular endothelial dysfunction results in increasedpermeability, hypercoagulability, and diffuse vasospasm.

The loss of protein through the kidney and excretion in the urine andthe alterations in the permeability of the vascular system due to thepotential endothelial dysfunction results in an increase in vascularpermeability. This enhanced vascular permeability ultimately permits theproteins, especially large proteins which are large molecules, to getthrough the capillaries and the glomerulus of the kidney. This loss ofprotein creates a potential need for large amounts of protein intakeduring pregnancy.

With incomplete protein breakdown due to the increased permeability ofthe vascular system, and its ability to permit large molecules into thevascular system, the protein requirements of the body during pregnancyare even greater than in the non-pregnant state. Further, with thesignificant loss of protein and the resultant dearth of amino acidspresent in the pregnant woman, the potential exists for organdysfunction and potential organ death.

The use of digestive enzymes can facilitate the presence of sufficientprotein so as not to allow the body to go into a negative proteinbalance. This is highly desirable as well as necessary due to the needfor proteases such that the body can facilitate formation of theplacenta as well as replacement proteins which are lost by the bodyduring the pregnancy.

In view of such findings, there is need for a method of treating thosewith preeclampsia such that the development of eclampsia/toxemia doesnot occur in pregnant women. The present invention is directed totherapeutic agents for the treatment of toxemia, preeclampsia andeclampsia and the method for preparing those agents. Further, thepresent invention is directed to the reduction of the formation ofhydatiform moles (molar pregnancies).

More specifically, the present invention relates to stablepharmaceutical preparations containing, but not limited to,digestive/pancreatic enzymes, including, but not limited to, amylases,proteases, cellulase, papaya, papain, bromelain, lipases, chymotrypsinand hydrolases. This combination is made by, but not limited to: directcompression, microencapsulation, lipid encapsulation, wet granulation orother methods including the use of Prosolv®, microencapsulation, lipidencapsulation technology, or other suitable technology. This technologycan include the use of rapid dissolution (rapid dissolve), time releaseor other delivery methods including oral, injection, patch or othermethod. Further, the delivery of the enzymes can be in the form of atablet, sprinkles, sachet, capsules, caplets or other compressed tabletdelivery, or other oral delivery method.

Further, the invention is directed toward the use of a biomarker, thepresence of chymotrypsin in the maternal GI tract to determine thelikelihood of developing preeclampsia, pregnancy induced hypertension,and eclampsia/toxemia.

SUMMARY OF THE INVENTION

It is a goal of the present invention to provide a therapeutic agent forthe treatment of pregnancy induced hypertension, toxemia, preeclampsiaand eclampsia and provide a method for preparing those agents.

Another goal of the present invention is to formulate stablepharmaceutical preparations containing, but not limited to,digestive/pancreatic enzymes including, but not limited to, amylases,proteases, cellulase, papaya, papain, bromelain, lipases, chymotrypsin;and hydrolases.

Yet another goal of the present invention is to make a combination ofdigestive/pancreatic enzymes is made by but not limited to: directcompression, microencapsulation, lipid encapsulation, wet granulation orother methods including the use of Prosolv®, and other known excipientsand additives to accomplish microencapsulation, lipid encapsulation,direct compression, wet or dry granulation or other suitable technology.

A further goal of the present invention is to deliver the preparation bymeans, which can include the use of rapid dissolution (rapid dissolve),time release, or other delivery methods including oral, injection,patch, or other method. Further, the delivery of the enzymes may be inthe form of a tablet, capsule, sprinkles, sachet, or other oral deliverymethod.

An additional goal of the invention is to demonstrate the use of fecalchymotrypsin as a prognosticative indicator of the presence ofpreeclampsia, eclampsia, toxemia or other disease of pregnancy, or thelikelihood of a woman to develop preeclampsia, eclampsia, toxemia, orpregnancy induced hypertension.

The features and advantages described herein are not all-inclusive and,in particular, many additional features and advantages will be apparentto one of ordinary skill in the art in view of the drawings,specification, and claims. Moreover, it should be noted that thelanguage used in the specification has been principally selected forreadability and instructional purposes, and not to limit the scope ofthe inventive subject matter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a table illustrating the changes in blood pressure, bothdiastolic and systolic, urine protein level, and fecal chymotrypsinlevel in pregnant women with preeclampsia that were administeredpancreatic enzymes.

FIG. 2 is a graph illustrating the changes in blood pressure ofpreeclamptic women over a 30 day period after being administeredpancreatic enzymes.

FIG. 3 is a graph illustrating the changes in urine protein level ofpreeclamptic women over a 30 day period after being administeredpancreatic enzymes.

FIG. 4 is a chart illustrating the fecal chymotrypsin levels inseventeen pregnant women from week 12 of pregnancy through week 40 ofpregnancy.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Since placental delivery reverses the symptoms of preeclampsia, itsuggests that the placenta has a central role in the condition.Additionally, women with increased placental tissue for gestational age,or those with hydatiform moles and twin pregnancies, have an increasedprevalence of preeclampsia. This leads one to consider the possibilitythat substances, such as human chorionic gonadotropin, which is presentin an increased amount in a hydatiform mole, may be involved. This linkbetween formation of the placenta and the development of preeclampsia iskey.

The formation of the syncytial trophoblast, and its secretion of steroidhormones keeps the levels of human chorionic gonadotropin low, andthereby reduces the likelihood of developing preeclampsia. The syncytialtrophoblast further proliferates to form a highly specializedtrophoblast, known as an extravillous trophoblast. The extravilloustrophoblast bores through the endometrium, extending to the decidua andmyometrium. These extravillous trophoblasts continue their invasion intothe spiral arterioles and replace the endothelial and muscular liningsof the uterine arterioles, leading to vasodilation of the uterinevasculature. This change ensures a continued low resistance system,which potentiates maternal blood flow to the intervillous space andmaintains adequate perfusion of the developing fetus.

The mechanism by which the cellular trophoblast is reduced in itsproliferation so that the syncytial trophoblast may take over is thepresence of proteolytic enzymes, especially that of chymotrypsin. Thematernal proteases, especially that of chymotrypsin, are able torestrain the proliferation of the cellular trophoblast and theoverproduction of human chorionic gonadotropin.

In one embodiment, a stable preparation of digestive/pancreatic enzymesis formed into a dosage formulation containing a therapeuticallyeffective amount of a protease, an amylase, and/or a lipase. Theformulation may include additional enzymes, such as pancreatin,chymotrypsin, trypsin, papain and/or papaya. Other combinations ofdigestive enzymes may also be used. These enzymes can be in the form ofanimal or plant derivatives, natural or synthetic.

The following outlines a formulary for digestive/pancreatic enzymes forpreeclampsia/toxemia:

Amylase 10,000-60,000 U.S.P

Protease 10,000-70,000 U.S.P

Lipase 4,000-30,000 U.S.P

Pancreatin 2,000-6,000 U.S.P

Chymotrypsin 2-5 mg

Trypsin 60-100 mg

Papain 3,000-10,000 USP units/mg

Papaya 30-60 mg

The dosage formulation may be administered by an oral preparationincluding, but not limited to, an encapsulated tablet, mini-tabs,microcapsule, mini-capsule, time released capsule, sprinkle or othermethodology. In one embodiment, the oral preparation is encapsulatedusing Prosolv technology. Alternatively, the oral preparation may beencapsulated using enteric coating, lipid encapsulation, directcompression, dry granulation, wet granulation, and/or a combination ofthese methods.

In a study conducted by the inventor, six women diagnosed withpreeclampsia in weeks 28-34 of pregnancy were examined. Each wasadministered pancreatic enzymes, including lipases, amylases andproteases, within two days of their diagnosis of preeclampsia for theduration of their pregnancy, while being monitored by theirobstetricians. The results of the study are found in FIG. 1, whichillustrates the changes in the womens' blood pressure, both diastolicand systolic, urine protein level, and fecal chymotrypsin levels.

As seen in FIG. 2, it is clear from the results that the blood pressuresof the pregnant women were reduced significantly over the 30 days ofadministration of the pancreatic enzymes. In every case, their bloodpressures returned to normal, which is usually 120/80. In some cases,the reversion to a normal blood pressure reading occurred within 15days.

Further, the levels of protein in their urine also reverted to normalwithin 30-35 days as seen in FIG. 3. Proteinuria is diagnosed byexamining the urine through a simple urinalysis. Normal urine has verysmall amounts of protein present. Larger amounts are usually reported as1+ to 4+.

In another study, shown in FIG. 4, seventeen women that were pregnantfor the first time (primipara) that were in their first trimester wereadministered a fecal chymotrypsin test every other week from week 12 toweek 40 of their pregnancy. One woman, subject 6, developed preeclampticsymptoms, and her fecal chymotrypsin test became abnormal one week priorto the diagnosis of preeclampsia.

Fecal chymotrypsin is a sensitive, specific measure of proteolyticactivity. Normal levels of chymotrypsin are considered be greater than8.4 U/gram. Decreased values (less than 4.2 U/gram) suggest diminishedpancreatic output (pancreatic insufficiency), hypoacidity of the stomachor cystic fibrosis. Elevated chymotrypsin values suggest rapid transittime, or less likely, a large output of chymotrypsin from the pancreas.

For the fecal chymotrypsin test, a stool sample was collected from eachof the subjects. Each stool sample was analyzed using an enzymaticphotospectrometry analysis to determine the level of fecal chymotrypsinin the stool. Alternatively, other methods, such as the colorimetricmethod, use of substrates, use of assays, and/or any other suitablemethod may be used to measure the fecal chymotrypsin levels. The levelsof fecal chymotrypsin in the samples of the primipara pregnant womenwere compared to the levels of fecal chymotrypsin in pregnant women notdiagnosed with preeclampsia to determine if the primipara pregnant womenwould benefit from the administration of digestive enzymes.

The foregoing description of the embodiments of the invention has beenpresented for the purposes of illustration and description. It is notintended to be exhaustive or to limit the invention to the precise formdisclosed. Many modifications and variations are possible in light ofthis disclosure. It is intended that the scope of the invention belimited not by this detailed description, but rather by the claimsappended hereto.

What is claimed is:
 1. A method for treating an individual exhibitingtoxemia, the method comprising administering a therapeutically effectiveamount of a pharmaceutical preparation comprising digestive enzymes tothe individual, wherein the digestive enzymes comprise an amylase, alipase, a protease, or a combination thereof, whereby toxemia istreated.
 2. The method of claim 1, wherein the protease compriseschymotrypsin or trypsin.
 3. The method of claim 1, wherein the digestiveenzymes are provided as pancreatin.
 4. The method of claim 1, whereinthe digestive enzymes are obtained from a source selected from the groupconsisting of animal enzymes, plant enzymes, synthetic enzymes, and acombination thereof.
 5. The method of claim 1, wherein thepharmaceutical preparation is manufactured using a technology selectedfrom the group consisting of enteric coating, lipid encapsulation,direct compression, dry granulation, wet granulation, and a combinationthereof.
 6. The method of claim 1, wherein the pharmaceuticalpreparation is administered orally via a dosage formulation selectedfrom the group consisting of: pills, tablets, capsules, microcapsules,mini-capsules, time released capsules, mini-tabs, sprinkles, and acombination thereof.
 7. The method of claim 1, wherein the amount ofamylase ranges from 10,000 to 60,000 USP units/dose.
 8. The method ofclaim 1, wherein the amount of protease ranges from 10,000 to 70,000 USPunits/dose.
 9. The method of claim 1, wherein the amount of lipaseranges from 4,000 to 30,000 USP units/dose.
 10. The method of claim 3,wherein the amount of pancreatin ranges from 2,000 to 6,000 USPunits/dose.
 11. The method of claim 2, wherein the amount ofchymotrypsin ranges from 2 to 5 mg/dose.
 12. The method of claim 2,wherein the amount of trypsin ranges from 60 to 100 mg/dose.